cell transplantation

cmv reactivation

cmv infection

hematopoietic cell

pediatric kidney

cmv disease

sot recipients

Biology of Blood and Marrow Transplantation

Introduction  Recipients of solid organ transplant (SOT) are at risk of viral infection and development of viral-driven malignancy (EBV-PTLD) due to immunosuppressive medications to prevent organ rejection. Treatments are limited by poor efficacy and organ toxicity, and reduction in immunosuppression to enable the patient's immune system fight the infection risks organ rejection. Allogeneic viral specific T-cells (VST) have been used to treat viral infections after stem cell transplant, and here we evaluated VST for the treatment of CMV, ADV, EBV-PTLD and BK in six SOT (heart, liver, kidney, lung) recipients.    Methods  Clinical descriptors of diagnosis, therapy and viral load in patients are presented.    Results  At the time of VST infusion, patients were a median of 16 years of age (range 2 - 69 years) with an average of 5 years post-SOT. Patients were on one or more immunosuppressive medications, including on Tacrolimus (3), prednisolone (4) and hydrocortisone (2). The majority of patients have received multiple monthly infusions to treat viral disease (range of 1-8). The HLA match between the VST unit and recipient ranged from 4/10 to 6/10. Class I matches were from 0/6 to 3/6, and Class II matches from 1/4 to 4/4. The treatment was safe with no serious adverse events observed. All patients had stable viral disease or a clinical response following VST infusion. The response was sustained over multiple infusions except one patient who showed a response to CMV after the first infusion but not after the second. This patient had a 5/10 match (3 class I and 2 class II match), liver transplant, and Tacrolimus treatment. Other patients with the same degree of match, virus infection, or immunosuppressant had continued responses and were not likely the cause of the loss of response and therefore could be immune mediated rejection of the VST. The presence of cells responding to viral peptides was evaluated in PBMC from five patients using IFNg ELIspot. Compared to pre-infusion, there was a higher number of responding...

Allogeneic Viral Specific T Cells Are Safe and Can be Efficient in the Treatment of Infections in Solid Organ Transplant Recipients